Physicians for Clinical Responsibility

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Welcome to Physicians for Clinical Responsibility. We live in a medical world increasingly influenced by business and government. Business interests sometimes seek to place profits over people. Government interests try to control things that the politicians know little about and are often influenced by those who seek their own interests. We don't have to do that. We simply have to get back to "patient-first" medicine.

PCR asks the question, "What if we could reclaim the world we first imagined, where the only imperative was to care for people?" What if research focused on improving what we already have instead of inventing something new and more expensive. What if we could force business and government to be respectful of our need to be advocates for our patients?

We can do it. We can't fix the whole world, but we can fix the part we touch. You can start here. Contribute. Criticize. Debate. Think. Suggest. This is an agenda-free zone. Join us. Click on the Register button to the left and you will be a=invited to the secure members discussion group.

The Gorilla in the Room

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A comic take that “nails it”

Ophthalmologists have been identified in the CMS data release as one of two leading cost centers for Medicare. This is exclusively because of Lucentis is, and more specifically exclusively due to the minority of retina doctors who use it.

This is resulting in extreme scrutiny of the specialty as a whole. Currently Lucentis costs all payers over 1/3 of the entire Medicare budget for all of eye care, although only a minority of doctors use it on a minority of patients. If everyone used it, just the new cases would cost not 1.6 billion but over 10 billion dollars per year. That doesn't even include the ongoing AMD cases, diabetes, vein occlusions, or the many other things this molecule (one, Lucentis, is essentially a fragment of the other, Avastin) can do.

Currently ophthalmology is grappling with important responses to this oppressive cost. New regulations that complicate or prevent legitimate care in an attempt to control abuses. Responding to patients who can and do lose their cars and homes and face bankruptcy from avoidable costs. Being in the uncomfortable position of being cast as the villains just for being the bill collectors for big PHARMA.

This doesn't have to be. Virtually all of this goes away if we stop using a drug, Lucentis, that has been shown in numerous studies to have no advantage over its parent, Avastin. Same with Eylea, which is priced like Avastin and “non-inferior” (i.e. no better than) Lucentis, which is equal to Avastin, which works the same at a fraction of the price. Stop using it or reprice it appropriately, and along with it other obscenely expensive new drugs. We simply need to break the paradigm of expensive retinal drugs started with Visudyne and continuing now. These costs are dragging the entire field under. If we don't act, we all go under: patients, doctors, and the companies. If we act and restore sanity, it is not to late to regain our integrity and our profession.